腸管虚血を合併したStanford A型急性大動脈解離に上腸間膜動脈バイパスを先行した1例

Stanford Type A Acute Aortic Dissection Complicated with Intestinal Ischemia Preceded by Superior Mesenteric Artery Bypass：Report of a Case

はじめに　腸管虚血は急性大動脈解離における大動脈破裂に次ぐ致死的な合併症であることが報告されている1）．われわれは，腸管虚血を合併したStanford A型急性大動脈解離（A型AAD）に上腸間膜動脈（SMA）バイパスを先行して行い，救命した1手術例を経験したので報告する．

A 78-year-old male with sudden onset of chest and back pain was transported to our institution by ambulance. Upon arrival at our hospital, he also complained of abdominal pain. Contrast-enhanced computed tomography （CT） revealed the presence of Stanford type A acute aortic dissection complicated with intestinal ischemia；because of the effects of aortic dissection, the superior mesenteric artery （SMA） was obstructed, leading to the complication of intestinal ischemia. An arterial blood gas test showed elevated lactate and metabolic acidosis. We immediately performed resection of the necrotic portion of the intestine and bypass of the common iliac artery to the SMA. Subsequently, after confirmation of the improvement of acidosis, ascending aortic replacement was performed on the same day. Although the patient’s condition was complicated by acute kidney injury and pneumonia, he was discharged home on the 55th postoperative day. Acute aortic dissection complicated by intestinal ischemia has a poor prognosis；however, here we reported a life-saving surgical procedure in a patient with this presentation.